Kneecapping Spokane

Since the end of World War II, the provision of medical care in the United States and other advanced countries has displayed three major features: first, rapid advances in the science of medicine; second, large increases in spending, both in terms of inflation-adjusted dollars per person and the fraction of national income spent on medical care; and third, rising dissatisfaction with the delivery of medical care, on the part of both consumers of medical care and physicians and other suppliers of medical care.

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Had Republicans agreed with President Obama on nothing more than this — had the above statement served as the rational starting point for discussion and debate, today America, and the entire world for that matter, would be spared watching such a destructive display of ineptitude and hypocrisy, interwoven with deceit and demagoguery.

Obama correctly stated that the United States was heading toward spending 17 percent of its gross domestic product on health care — fully 5 percentage points higher than the next industrialized country — while producing mediocre results. Coverage was terrible, and America was ranked 31st by the World Health Organization for overall health care results. Consider just one factor: In infant mortality, America ranked behind Cuba.

Instead of engaging the problem, Republicans, including the likes of our own Cathy McMorris Rodgers, stalked the halls of Congress chanting, "America has the best health care system in the world." They relied on the same mindless, self-serving, anti-science nonsense that their climate-change deniers rely on today.

And now, to no one's surprise, they are making a mess of things. According to Congressional Budget Office estimates, if the GOP health care reform proposal becomes law, up to 24 million Americans will lose coverage by 2026; the cost will go up for all but the most affluent. Economist Paul Krugman, after sorting all this out, leaves us with this simple explanation: "Republicans were lying all along, and still are."

Given all the obfuscation and denial, some very serious questions were not confronted — cost containment over time being at the top of the list. But the coverage the ACA did provide, it turns out, is highly popular — yet that's what the Republican plan would dramatically reduce.

In 2010 the Democrats lost control of Congress. How did this happen? I suggest that it was because they ignored the old Tip O'Neill axiom: "All politics is local." They lost connection with their natural constituencies. They blew off labor unions, blew off local organizing, became mired in identity politics and were being led around by a Democratic National Committee that preferred top-down campaigns. Factor in Citizens United, plus what the Supreme Court did to the Voting Rights Act, and today not only are Democrats in the minority at both the state and congressional levels, they are also staring at a stacked deck.

Still there's a strong local case to be made against Trump and his acolytes. Democrats, however, haven't made it. Trickle-down policies have promoted inequality and failed to address the realities of a service economy.

Today, our most important payrolls — upon which our small business economy depends — are Fairchild Air Force Base, the health care sector, education, and city and county government. These all are either service-sector, government or nonprofit. Our medical community is especially vulnerable, with Medicaid funding in Spokane being the foundation of many medical practices and patients' futures. Trump and McMorris Rodgers threaten all of this with their plans to cut into that safety net.

By backing this ill-conceived ACA "repeal and replace," McMorris Rodgers is showing how terrible she is on health care — one of her district's keystone economic elements. We already knew she was bad on the environment, on women's rights and on public education. And judging by recent events, she obviously has zero influence over what happens to Fairchild. But the fact is that local Democrats have done a miserable job of confronting her on her record. Every challenger since 2000 has run not so much a political campaign but what, for want of a better term, might be termed a "politeness campaign."

Against all odds, Spokane has accomplished much over the past 20 or 30 years. Consider just some of the success stories: From the salvation of Browne's Addition, to the rediscovery of South Perry, to the Fox, to the Davenport, to the old Penney's building, to Kendall Yards, to the WSU medical school, to the Grand Hotel, to restoration of many high schools and construction of elementary schools, to the redo of Riverfront Park, to all the brewery startups.

The last thing Spokane needs is for McMorris Rodgers and her party to attack such community cornerstones as Community Development Block Grant funding, public radio, public television, Planned Parenthood, early childhood development funding, public education and much more. Indeed, given their attacks on immigrants, even agriculture is threatened.

As for my opening quote regarding health care problems in America? This statement wasn't written by Barack Obama or some flaming liberal, but by that archconservative economist who advised both Ronald Reagan and Margaret Thatcher: Milton Friedman. ♦